Table 2.
Significant factors associated with the final place of care in bivariate analysis
| Variables | Final place of care | Adjusted P-valuea | ||
|---|---|---|---|---|
| Home (N = 209) |
Inpatient hospice (N = 85) |
Hospital (N = 60) |
||
| Age (years) | ||||
| Median (IQR) | 79 (70–86) | 71 (65–81) | 71 (64–80) | < 0.0001b |
| Mean (SD) | 77.7 (11.6) | 71.6 (12.0) | 72.3 (9.9) | < 0.0001c |
| Gender | ||||
| Male | 96 (45.9) | 46 (54.1) | 39 (65.0) | 0.252b |
| Female | 113 (54.1) | 39 (45.9) | 21 (35.0) | 0.014c |
| Marital status | ||||
| Single | 8 (3.8) | 18 (21.2) | 6 (10.0) | |
| Married | 100 (47.8) | 38 (44.7) | 40 (66.7) | |
| Divorced | 7 (3.3) | 9 (10.6) | 2 (3.3) | <0.0001b |
| Widowed | 94 (45.0) | 20 (23.5) | 12 (20.0) | 0.003c |
| Housing type | ||||
| Rental | 11 (5.3) | 14 (16.5) | 6 (10.0) | |
| Public | 169 (80.9) | 68 (80.0) | 50 (83.3) | |
| Private condominium | 15 (7.2) | 2 (2.4) | 2 (3.3) | 0.002b |
| Private landed housing | 14 (6.7) | 1 (1.2) | 2 (3.3) | 0.300c |
| Government financial support level | ||||
| High | 117 (56.0) | 67 (78.8) | 33 (55.0) | |
| Medium | 20 (9.6) | 7 (8.2) | 9 (15.0) | |
| Low | 23 (11.0) | 5 (5.9) | 7 (11.7) | 0.001b |
| No support | 49 (23.4) | 6 (7.1) | 11 (18.3) | 0.605c |
| Cancer site | ||||
| Brain | 6 (2.9) | 1 (1.2) | 2 (3.3) | |
| Head and neck | 3 (1.4) | 5 (5.9) | 5 (8.3) | |
| Gastrointestinal system | 54 (25.8) | 27 (31.7) | 14 (23.3) | |
| Hepatobiliary pancreatic system | 36 (17.2) | 15 (17.6) | 14 (23.3) | |
| Breast | 18 (8.6) | 2 (2.4) | 4 (6.7) | |
| Gynecological | 3 (1.4) | 0 | 0 | |
| Genitourinary | 12 (5.7) | 5 (5.9) | 3 (5.0) | |
| Hematological | 10 (4.8) | 2 (2.4) | 1 (1.7) | |
| Prostate | 5 (2.4) | 2 (2.4) | 3 (5.0) | |
| Skin | 0 | 2 (2.4) | 1 (1.7) | |
| Lung | 50 (23.9) | 17 (20.0) | 8 (13.3) | |
| Multiple sites | 4 (1.9) | 4 (4.7) | 2 (3.3) | |
| Unknown | 8 (3.8) | 1 (1.2) | 2 (3.3) | 0.024b |
| Others | 0 | 2 (2.4) | 1 (1.7) | 0.001c |
| Cardiovascular disease | 72 (34.4) | 20 (23.5) | 6 (10.0) | 0.091b |
| < 0.0001c | ||||
| Dementia | 35 (16.7) | 5 (5.9) | 1 (1.7) | 0.023b |
| 0.005c | ||||
| Main caregiver availability | 207 (99.0) | 61 (71.8) | 53 (88.3) | < 0.0001b |
| Family | 72 (34.8) | 38 (62.3) | 34 (64.2) | < 0.0001c |
| Friend | 0 | 2 (3.3) | 2 (3.8) | |
| Foreign domestic helper | 129 (62.3) | 21 (34.4) | 15 (28.3) | < 0.0001b |
| Private/interim care nurse | 6 (2.9) | 0 | 2 (3.8) | < 0.0001c |
| Family caregiver age (years) | ||||
| Median (IQR) | 54 (47–62) | 61.5 (50.5–69) | 51.5 (45–65) | 0.007b |
| Mean (SD) | 53.6 (12.8) | 58.5 (13.7) | 54.2 (14.6) | 0.932c |
| Patient’s PPOC | 138 (66.0) | 70 (82.4) | 41 (68.3) | |
| Home | 135 (97.8) | 31 (44.3) | 21 (51.2) | |
| Inpatient hospice | 1 (0.7) | 38 (54.3) | 3 (7.3) | |
| Hospital | 1 (0.7) | 0 | 16 (39.0) | |
| No preference | 0 | 1 (1.4) | 0 | < 0.0001b |
| Any institution | 1 (0.7) | 0 | 1 (2.4) | < 0.0001c |
| Patient’s PPOD | 136 (65.1) | 70 (82.4) | 35 (58.3) | |
| Home | 130 (95.6) | 33 (47.1) | 25 (71.4) | |
| Inpatient hospice | 1 (0.7) | 34 (48.6) | 5 (14.3) | |
| Hospital | 1 (0.7) | 0 | 2 (5.7) | |
| No preference | 3 (2.2) | 3 (4.3) | 1 (2.9) | < 0.0001b |
| Any institution | 1 (0.7) | 0 | 2 (5.7) | < 0.0001c |
| Family’s PPOC | 207 (99.0) | 72 (84.7) | 47 (78.3) | |
| Home | 202 (97.6) | 7 (9.7) | 7 (14.9) | |
| Inpatient hospice | 3 (1.4) | 65 (90.3) | 14 (29.8) | |
| Hospital | 2 (1.0) | 0 | 23 (48.9) | |
| No preference | 0 | 0 | 1 (2.1) | < 0.0001b |
| Any institution | 0 | 0 | 2 (4.3) | < 0.0001c |
| Family’s PPOD | 206 (98.6) | 72 (84.7) | 42 (70.0) | |
| Home | 196 (95.1) | 8 (11.1) | 16 (38.1) | |
| Inpatient hospice | 4 (1.9) | 63 (87.5) | 14 (33.3) | |
| Hospital | 2 (1.0) | 0 | 8 (19.0) | |
| No preference | 4 (1.9) | 1 (1.4) | 2 (4.8) | < 0.0001b |
| Any institution | 0 | 0 | 2 (4.8) | < 0.0001c |
| Duration of enrollment in the home-based care service (days) | ||||
| Median (IQR) | 59 (32–124) | 92 (57–168) | 63 (42.5–160) | < 0.0001b |
| Mean (SD) | 93.7 (93.0) | 130.1 (103.3) | 107.6 (100.7) | 0.080c |
| Number of emergency department visits | ||||
| Median (IQR) | 0 | 0 (0–1) | 0 (0–1) | < 0.0001b |
| Mean (SD) | 0.3 (0.8) | 0.7 (1.0) | 0.7 (1.4) | 0.054c |
| Number of hospital admissions | ||||
| Median (IQR) | 0 (0–1) | 1 (0–1) | 0 (0–1) | < 0.0001b |
| Mean (SD) | 0.4 (0.8) | 0.9 (1.0) | 0.8 (1.7) | 0.196c |
| Average length of hospitalization (days) | ||||
| Median (IQR) | 0 (0–4) | 5 (0–11) | 0 (0–5.5) | < 0.0001b |
| Mean (SD) | 2.8 (6.2) | 8.8 (11.0) | 4.5 (9.4) | 0.205c |
| PPSv2 2 weeks before death or admission to the final place of care | ||||
| 10% | 77 (36.8) | 0 | 0 | |
| 20% | 45 (21.5) | 3 (3.5) | 4 (6.7) | |
| 30% | 45 (21.5) | 14 (16.5) | 7 (11.7) | |
| 40% | 21 (10.0) | 25 (29.4) | 11 (18.3) | |
| 50% | 8 (3.8) | 19 (22.4) | 22 (36.7) | |
| 60% | 4 (1.9) | 4 (4.7) | 8 (13.3) | |
| 70% | 1 (0.5) | 2 (2.4) | 1 (1.7) | |
| 80% | 0 | 0 | 1(1.7) | <0.0001b |
| Missing | 8 (3.8) | 18 (21.2) | 6 (10.0) | <0.0001c |
| ESASr 2 weeks before death or admission to the final place of care | ||||
| Pain | ||||
| Median (IQR) | 0 (0–2) | 0 (0–3) | 2.5 (0–3) | < 0.0001b |
| Mean (SD) | 0.9 (1.7) | 2.2 (2.7) | 2.1 (2.4) | <0.0001c |
| Nausea | ||||
| Median (IQR) | 0 | 0 | 0 | 0.007b |
| Mean (SD) | 0.2 (0.9) | 0.6 (1.5) | 0.6 (1.7) | 0.047c |
| Depression | ||||
| Median (IQR) | 0 | 0 | 0 | < 0.0001b |
| Mean (SD) | 0.2 (0.8) | 1.1 (2.1) | 0.9 (2.2) | 0.001c |
| Drowsiness | ||||
| Median (IQR) | 3 (0–8) | 0 (0–5) | 0 (0–3) | 0.002b |
| Mean (SD) | 4.1 (3.8) | 2.5 (3.1) | 2.0 (2.8) | < 0.0001c |
| Appetite | ||||
| Median (IQR) | 5 (0–9) | 5 (3–6.5) | 3 (0–5) | 0.608b |
| Mean (SD) | 4.6 (3.9) | 4.3 (3.1) | 3.1 (2.8) | 0.015c |
| Well-being | ||||
| Median (IQR) | 0 (0–3) | 3 (0–6) | 3 (0–5) | 0.001b |
| Mean (SD) | 1.8 (2.5) | 3.1 (2.9) | 2.6 (2.7) | 0.028c |
Results are reported as frequencies with percentages unless otherwise stated
IQR, interquartile range; SD, standard deviation; PPOC, preferred place of care; PPOD, preferred place of death; PPSv2, Palliative performance scale v2 is a valid and reliable tool ranging from 0% (death) to 100% (normal function) for assessing the functional status of palliative care patients [36, 37]; ESASr, Edmonton symptom assessment scale is a psychometrically tested tool that uses a numeric rating scale ranging from 0 (no symptom) to 10 (worst) for measuring the symptom severity of nine symptoms (pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, well-being and dyspnea). Additional symptoms can be recorded if present. Individual symptom scores are summed with a higher total score indicating worse symptom burden [38, 39]
aTo control for type 1 error in multiple comparisons, Bonferroni adjustment was applied to the p-value. With three pairwise comparisons, the adjusted p-value for statistical significance was 0.017
bAdjusted p-value when patients whose final place of care was in the inpatient hospice were compared to patients whose final place of care was at home
cAdjusted p-value when patients whose final place of care was in the hospital were compared to patients whose final place of care was at home